Virtual Reality Goggles as a Distraction Technique for Managing Behavioral Conduct During Pulp Pediatric Dental Treatment: A Systematic Review and Meta-Analysis.

Objective: To systematically evaluate the effectiveness of virtual reality (VR) distraction systems in reducing pain perception and dental anxiety during pediatric pulp therapy procedures. Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD42026139774). PubMed/MEDLINE, Scopus, and Embase were searched for randomized clinical trials evaluating immersive VR distraction during pediatric pulp therapy. Risk of bias was assessed using RoB 2, and certainty of evidence was evaluated with GRADE. Random-effects meta-analysis was performed for pain outcomes. Results: Seven randomized clinical trials were included in the qualitative synthesis. Three parallel-group randomized controlled trials were included in the pain meta-analysis. VR distraction significantly reduced self-reported pain (SMD) = -1.28 (95% C.I. = -2.49 to -0.07; p = 0.038) compared with control interventions. Substantial heterogeneity was observed for both outcomes (I2 > 93%). Most studies also reported improvements in behavioral cooperation, whereas physiological measures showed inconsistent findings. The certainty of evidence was rated as low for pain and anxiety outcomes. Conclusions: VR distraction may represent a promising non-pharmacological behavioral management strategy for reducing pain perception and dental anxiety during pediatric pulp therapy. However, these findings should be interpreted with caution because they are based on a small number of studies with substantial methodological heterogeneity. Further well-designed randomized clinical trials using standardized intervention protocols and outcome measures are required before firm conclusions or recommendations for routine clinical implementation can be established.